Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study

Autoři: Fiona G. Kouyoumdjian aff001;  Ji Yun Lee aff004;  Aaron M. Orkin aff005;  Stephanie Y. Cheng aff002;  Kinwah Fung aff002;  Tim O’Shea aff008;  Gordon Guyatt aff008
Působiště autorů: Department of Family Medicine, McMaster University, Hamilton, Canada aff001;  ICES, Toronto, Canada aff002;  Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada aff003;  Faculty of Health Sciences, McMaster University, Hamilton, Canada aff004;  Department of Emergency Medicine, St Joseph’s Health Centre, Unity Health, Toronto, Canada aff005;  Department of Family and Community Medicine, University of Toronto, Toronto, Canada aff006;  Dalla Lana School of Public Health, University of Toronto, Toronto, Canada aff007;  Department of Medicine, Faculty of Medicine, McMaster University, Hamilton, Canada aff008
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article


We aimed to compare 30-day readmission after medical-surgical hospitalization for people who experience imprisonment and matched people in the general population in Ontario, Canada. We used linked population-based correctional and health administrative data. Of people released from Ontario prisons in 2010, we identified those with at least one medical or surgical hospitalization between 2005 and 2015 while they were in prison or within 6 months after release. For those with multiple eligible hospitalizations, we randomly selected one hospitalization. We stratified people by whether they were in prison or recently released from prison at the time of hospital discharge. We matched each person with a person in the general population based on age, sex, hospitalization case mix group, and hospital discharge year. Our primary outcome was 30-day hospital readmission. We included 262 hospitalizations for people in prison and 1,268 hospitalizations for people recently released from prison. Readmission rates were 7.7% (95%CI 4.4–10.9) for people in prison and 6.9% (95%CI 5.5–8.3) for people recently released from prison. Compared with matched people in the general population, the unadjusted HR was 0.72 (95%CI 0.41–1.27) for people in prison and 0.78 (95%CI 0.60–1.02) for people recently released from prison. Adjusted for baseline morbidity and social status, hospitalization characteristics, and post-discharge health care use, the HR for 30-day readmission was 0.74 (95%CI 0.40–1.37) for people in prison and 0.48 (95%CI 0.36–0.63) for people recently released from prison. In conclusion, people recently released from prison had relatively low rates of readmission. Research is needed to elucidate reasons for lower readmission to ensure care quality and access.

Klíčová slova:

Critical care and emergency medicine – Hospitalizations – Hospitals – Morbidity – Ontario – Pregnancy – Primary care – Prisons


1. Axon RN, Williams MV. Hospital readmission as an accountability measure. JAMA. 2011;305(5):504–5. Epub 2011/02/03. doi: 10.1001/jama.2011.72 21285430.

2. Joynt KE, Jha AK. Thirty-day readmissions—truth and consequences. The New England journal of medicine. 2012;366(15):1366–9. Epub 2012/03/30. doi: 10.1056/NEJMp1201598 22455752.

3. Jha AK. Death, readmissions, and getting policy right. JAMA Network Open. 2018;1(5).

4. van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2011;183(7):E391–402. Epub 2011/03/30. doi: 10.1503/cmaj.101860 21444623.

5. Kangovi S, Grande D. Hospital readmissions—not just a measure of quality. JAMA. 2011;306(16):1796–7. Epub 2011/10/27. doi: 10.1001/jama.2011.1562 22028356.

6. Friedman B, Basu J. The rate and cost of hospital readmissions for preventable conditions. Med Care Res Rev. 2004;61(2):225–40. Epub 2004/05/25. doi: 10.1177/1077558704263799 15155053.

7. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41. Epub 2007/03/01. doi: 10.1001/jama.297.8.831 17327525.

8. Fazel S, Baillargeon J. The health of prisoners. Lancet. 2011;377(9769):956–65. Epub 2010/11/26. doi: 10.1016/S0140-6736(10)61053-7 21093904.

9. Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, et al. Release from prison—a high risk of death for former inmates. The New England journal of medicine. 2007;356(2):157–65. doi: 10.1056/NEJMsa064115 17215533.

10. Wang EA, Wang Y, Krumholz HM. A high risk of hospitalization following release from correctional facilities in Medicare beneficiaries: a retrospective matched cohort study, 2002 to 2010. JAMA internal medicine. 2013;173(17):1621–8. doi: 10.1001/jamainternmed.2013.9008 23877707.

11. Howell BA, Long JB, Edelman EJ, McGinnis KA, Rimland D, Fiellin DA, et al. Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort. Journal of general internal medicine. 2016;31(12):1496–502. Epub 2016/09/14. doi: 10.1007/s11606-016-3857-1 27619934.

12. Kouyoumdjian F, Kiefer L, Wobeser W, Hwang SW. High mortality over 12 years of follow up in people admitted to provincial custody in Ontario: A retrospective cohort study. Canadian Medical Association Journal Open. 2016;4(2):E153–E61.

13. Kouyoumdjian FG, Cheng SY, Fung K, Orkin AM, McIsaac KE, Kendall C, et al. The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada. PLoS One. 2018;13(8):e0201592. Epub 2018/08/04. doi: 10.1371/journal.pone.0201592 30075019.

14. Baillargeon J, Hoge SK, Penn JV. Addressing the challenge of community reentry among released inmates with serious mental illness. American journal of community psychology. 2010;46(3–4):361–75. doi: 10.1007/s10464-010-9345-6 20865315.

15. Bergseth K K RJ, Bergeron-Vigesaa L, McDonald T. Assessing the Needs of Women Recently Released From Prison. Women & Criminal Justice. 2011;21(2):100–22.

16. Colbert AM, Durand V. Women in Transition to Health: A Theory-Based Intervention to Increase Engagement in Care for Women Recently Released From Jail or Prison. Journal of forensic nursing. 2016;12(1):19–25. doi: 10.1097/JFN.0000000000000102 26859642.

17. Graffam J, Shinkfield A, Lavelle B, McPherson W. Variables affecting successful reintegration as perceived by offenders and professionals. Journal of Offender Rehabilitation. 2005;40(1):147–71.

18. Ramaswamy M, Upadhyayula S, Chan KY, Rhodes K, Leonardo A. Health priorities among women recently released from jail. American journal of health behavior. 2015;39(2):222–31. doi: 10.5993/AJHB.39.2.9 25564835.

19. Fahmy N, Kouyoumdjian FG, Berkowitz J, Fahmy S, Neves CM, Hwang SW, et al. Access to Primary Care for Persons Recently Released From Prison. Ann Fam Med. 2018;16(6):549–51. Epub 2018/11/14. doi: 10.1370/afm.2314 30420371.

20. Kinner SA. The case for improving the health of ex-prisoners. American Journal of Public Health. 2014;104(8):1352–5. doi: 10.2105/AJPH.2014.301883 24922122

21. Reitano J. Adult correctional statistics in Canada, 2015/2016. 2017.

22. Hu C, Jurgutis J, Kouyoumdjian F. Achieving continuity of care for people at the time of release from provincial prison in Ontario: A pilot study to define barriers and opportunities. 2019.

23. Government of Ontario. Apply for OHIP and get a health card 2017 [updated May 28, 2018; cited 2018 September 26].

24. Pink GH, Bolley HB. Physicians in health care management: 4. Case Mix Groups and Resource Intensity Weights: physicians and hospital funding. CMAJ. 1994;150(8):1255–61. Epub 1994/04/15. 8162548.

25. The Johns Hopkins University. The Johns Hopkins ACG® System 2018.

26. Austin PC, van Walraven C, Wodchis WP, Newman A, Anderson GM. Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada. Medical care. 2011;49(10):932–9. doi: 10.1097/MLR.0b013e318215d5e2 21478773.

27. Institute for Clinical Evaluative Sciences. Mental Health and Addictions System Performance in Ontario: A Baseline Scorecard: Technical Appendix 2018 [cited 2018 September 26 2018].

28. Saab D, Nisenbaum R, Dhalla I, Hwang SW. Hospital Readmissions in a Community-based Sample of Homeless Adults: a Matched-cohort Study. Journal of general internal medicine. 2016;31(9):1011–8. Epub 2016/05/21. doi: 10.1007/s11606-016-3680-8 27197973.

29. Austin P. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput. 2009;38(6):1228–34.

30. Urach C, Zauner G, Wahlbeck K, Haaramo P, Popper N. Statistical methods and modelling techniques for analysing hospital readmission of discharged psychiatric patients: a systematic literature review. BMC Psychiatry. 2016;16(1):413. Epub 2016/11/20. doi: 10.1186/s12888-016-1128-7 27863514.

31. Canadian Institutes of Health Research NSaERCoC, Social Sciences and Humanities Research Council of Canada,. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. 2014.

32. Kouyoumdjian F, Schuler A, Matheson FI, Hwang SW. The health status of prisoners in Canada: A narrative review. Canadian Family Physician. 2016;62(3):215–22. 27427562

33. Balogh R, Lin E, Dobranowski K, Selick A, Wilton AS, Lunsky Y. All-Cause, 30-Day Readmissions Among Persons With Intellectual and Developmental Disabilities and Mental Illness. Psychiatr Serv. 2018;69(3):353–7. Epub 2017/11/16. doi: 10.1176/ 29137556.

34. Frank JW, Wang EA, Nunez-Smith M, Lee H, Comfort M. Discrimination Based on Criminal Record and Healthcare Utilization Among Men Recently Released from Prison. Health Justice. 2014;2(6).

35. Pager D. The Mark of a Criminal Record. American Journal of Sociology. 2003;108(5):937–75.

36. Turney K, Lee H, Comfort M. Discrimination and psychological distress among recently released male prisoners. Am J Mens Health. 2013;7(6):482–93. Epub 2013/04/05. doi: 10.1177/1557988313484056 23553444.

37. Green S, Foran J, Kouyoumdjian FG. Access to primary care in adults in a provincial correctional facility in Ontario. BMC Res Notes. 2016;9:131. doi: 10.1186/s13104-016-1935-4 26923923.

38. Ti L, Ti L. Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review. Am J Public Health. 2015;105(12):e53–9. Epub 2015/10/16. doi: 10.2105/AJPH.2015.302885 26469651.

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